Good for national health insurance

Kim Sung-soo

In a board meeting last month, the National Health Insurance Service approved a motion proposing to file a lawsuit against domestic and foreign cigarette companies to seek reimbursement for public health costs related to smoking. The move could help to ease public anxiety about the public insurer’s financial health. Harmful health effects from smoking are widely known. A cigarette contains more than 60 types of carcinogenic substances and the key toxic chemical, nicotine, is more addictive than cocaine, marijuana, alcohol and propofol.

According to the state insurance agency, habitual smokers are likely to fall ill much easier than nonsmokers. Active male adult smokers develop laryngeal cancer 6.5 times more often than nonsmokers and lung cancer 4.6 times more. In female smokers, the risk of laryngeal cancer increased by 5.5 times and pancreatic cancer by 3.6 times. In 2012, more than 58,000 of 267,221 people died from smoking-related diseases. The social and economic costs from losses and treatment also snowballed to 10 trillion won ($9.41 billion) a year.

The public insurer is seeking legal damages against tobacco companies on several grounds. First, risks and dangers to public health from smoking have reached serious levels as statistics attest. Nonsmoking campaigns must be more proactively pursued through mandatory financial restraint on marketing practices by tobacco companies. Second, due to increasing illnesses from smoking, treatment translates into a significant burden on the public health system. In 2011, the insurer spent 1.7 trillion won on health coverage for smoking-related diseases. Meanwhile, tobacco companies enjoy sizable profits every year. Third, smoking is an act of free will, but due to its addictive nature, cigarette companies must share part of the responsibility for the harm.

Smokers pay 354 won in health taxes for every pack of cigarettes they buy. Citizens, including nonsmokers on the public health insurance scheme, contribute 1.7 billion won a year for smoking-related funds.

It just does not make sense in terms of social justice for tobacco manufacturers that are directly responsible for supplying the health-hazardous item to be exempted from cost sharing. They should face the same liability as employers whose employees are injured or become ill at industrial or work sites.

The state insurer is responsible for the public health system and is justified to take legal actions against the producers of smoking-related illnesses to seek damages. The United States has long suffered losses in Medicaid from health expenses incurred in the treatment of diseases caused by smoking. In the 1990s, the 50 states commenced multibillion-dollar litigation against the tobacco industry. Pressured under the collective action, major tobacco companies entered into a national legislative settlement that included a payment by the companies of $205 billion in 1998 - worth 210 trillion won today - plus stronger warning labels and restrictions on advertising.

The fund helped to ease losses in Medicaid and fund scientific and medical research on the dangers of cigarettes and nonsmoking campaigns for youths.

The time has come for us to take stronger action. We must pursue state-level tobacco litigation and control in order to sustain the solidity of our national health insurance scheme and reduce preventable diseases from smoking.

Translation by the Korea JoongAng Daily staff.

JoongAng Ilbo, Feb. 8, Page 28

*The author is a doctor and partner of legal firm Jipyong, specializing in labor, employment and health care.

By Kim Sung-soo